Measurement Technology Northwest (United States)

Appropriate Use Criteria Clinical Decision Support (AUC CDS) was legislatively mandated in the United States in 2014, and multiple CDS vendors were designated as qualified Clinical Decision Support Mechanisms by the Centers for Medicare and Medicaid Services. Little is known about the costs and benefits of these systems in real-world settings.We evaluated the effectiveness of an AUC CDS system and the time costs it imposes on clinicians at an academic medical center.Our U.S. academic medical center's enterprise data warehouse was queried for AUC CDS alert events and timestamps occurring between July 1, 2021, and June 30, 2022. We calculated the percentage of altered orders and alert-related timespans, and used these to calculate CDS positive predictive value (PPV), time costs, and the cost-benefit ratio of minutes of provider time per altered order. Based on the medical literature and expert opinion on well-performing CDS, we hypothesized a CDS PPV of 8%.Overall PPV was 1%, leading us to reject our hypothesis that our CDS was well-performing (p < 0.001). Median time costs per alert were high (12 seconds load time, 2 seconds dwell time), yielding a CDS cost-benefit ratio of 38 provider minutes per altered order.Despite using one of three market-leading AUC CDS tools, our CDS demonstrated long load times, short dwell times, and low PPV. Provider attention is not free-policymakers should consider both CDS effectiveness and costs (including time costs) when designing AUC policy.

Results of a design data development program involving hundreds of graphite epoxy bolted joint tests are summarized. Emphasis was on obtaining information for HMF330C/34 cloth material at room temperature, 394, and 450 K; however, many specimens made from T300/5208 and AS/3501 tape laminates were tested to provide correlating information on bearing behavior and the importance of hole-bolt tolerances. Bearing strengths for quasi-isotropic laminates made from these three prepregs were similar. Complete removal of bolt torque was shown to reduce the bearing strength relative to fully torqued bolts by approximately 40 percent. Multiple bolt joints were tested using three different hole-bolt tolerances. Resulting strengths were encouragingly similar, indicating the materials were less brittle than might have been expected. This was particularly true for bearing failures. Loaded-bolt and open-hole tests on cloth laminates indicated a greater degree of effective ductility than indicated by available data for similar tape laminates. Layups with no 45-deg plies exhibited markedly greater brittleness than their quasi-isotropic brethren. The higher the temperature, the less was the ductility for both layups. Bolt head details were shown to exercise a strong influence on bearing strength for single lap joints.